Harris Katherine M, Uscher-Pines Lori, Mattke Soeren, Kellermann Arthur L
Rand Health Q. 2012 Mar 1;2(1):15. eCollection 2012 Spring.
Vaccine-preventable disease continues to take a heavy toll on adults despite the widespread availability of effective vaccines. This article identifies where efforts to improve the delivery of adult vaccination have stalled and recommends targeted strategies that are supported by available evidence and build on existing infrastructure. The authors conducted a comprehensive review of the published literature on adult immunization, a stakeholder workshop, and follow-up interviews with meeting participants and additional experts. They also partnered with an organization represented at the workshop to conduct a telephone survey of adults to learn about the relationship between influenza vaccination and beliefs about the safety of influenza vaccine. Findings include that office-based providers remain the primary source of vaccination, though a substantial proportion of physicians who treat adults appear not to vaccinate at all and adult vaccination is infrequently discussed at health care encounters. Adult practices also lack a strong business case to offer vaccination, as it entails substantial fixed costs. In addition, achieving substantial increases in adult vaccination will require persuading large numbers of individuals disinclined to be vaccinated. Vaccination stakeholders need to engage in a collaborative fashion to promote adult vaccination and the integration of advice about vaccination into routine office-based practice. Recommendations include strengthening evidence surrounding practice gaps and the economic value of promoting vaccination in office-based settings, improving guidance to providers about vaccinating adults, and formalizing procedures for referring patients to complementary vaccinators.
尽管有效疫苗已广泛可得，但疫苗可预防疾病仍继续给成年人造成沉重负担。本文确定了在改善成人疫苗接种服务方面的努力停滞在何处，并推荐了有现有证据支持且基于现有基础设施的针对性策略。作者对已发表的关于成人免疫接种的文献进行了全面综述，举办了一次利益相关者研讨会，并对会议参与者和其他专家进行了后续访谈。他们还与研讨会上有代表出席的一个组织合作，对成年人进行了电话调查，以了解流感疫苗接种与对流感疫苗安全性的看法之间的关系。研究结果包括，以诊所为基础的医疗服务提供者仍然是疫苗接种的主要来源，不过很大一部分治疗成人的医生似乎根本不进行疫苗接种，而且在医疗服务过程中很少讨论成人疫苗接种问题。成人诊所也缺乏提供疫苗接种的有力商业理由，因为这需要大量固定成本。此外，要大幅提高成人疫苗接种率，就需要说服大量不愿接种疫苗的人。疫苗接种利益相关者需要以合作的方式促进成人疫苗接种，并将疫苗接种建议纳入日常的诊所医疗服务中。建议包括加强有关诊所医疗服务中的实践差距以及推广疫苗接种的经济价值的证据，改进对医疗服务提供者进行成人疫苗接种的指导，并规范将患者转介给其他疫苗接种者的程序。
